Kyle Ford Gordon, MD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

13240 Issued in MS

Practice address

970 Lakeland Dr Ste 40
Jackson, MS 39216-4640

Phone

(601) 200-4850

Fax

(601) 200-4838

NPI assigned

Nov 2, 2006

Last updated

Feb 26, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Otolaryngology

Education

Tulane University School of Medicine, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

ENT Surgical Group PLLCGroup PAC ID 8123487584, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Dominic-Jackson Memorial Hospital Hospital, Jackson, MS, CCN 250048

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• ENT Surgical Group, PLLC

  • Otolaryngology Physician
  • Madison, MS
  • NPI 1023734878
  Medicare reassignment Care Compare group NPD Authorized official

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Dominic-Jackson Memorial Hospital

  • General Acute Care Hospital
  • Jackson, MS
  • NPI 1306876065
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551139200000",
    "number": "1811076938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23666",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392253666",
            "telephone_number": "601-200-4749",
            "fax_number": "601-200-5929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "970 LAKELAND DR STE 40",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164640",
            "telephone_number": "601-200-4850",
            "fax_number": "601-200-4838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "KYLE",
        "middle_name": "FORD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2019-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MS",
            "license": "13240",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04124592",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cameron Gordon
• Catherine J Gordon, M.D.
• Jerome Gordon Jr., OTR-L
• Felix Gordon, Jr., M.D.
• Kenisha Wheeler Gordon, LPC
• Latoyia Gordon
• Marcus Leroy Gordon, R PH
• Rita L Gordon, APRN
• Frances Moran Gordy, D.M.D.
• Mary Gordy, NP

• Otolaryngology Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Otolaryngology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.